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FRANKLIN, Tenn. – Citing the recently released U.S. Department of Health and
Human Services (HHS)
semi-annual report to Congress and the HHS
Office of Inspector General (OIG) 2009
Work Plan, executives from
Passport Health
Communications, Inc. assert that declining Medicare and Medicaid
reimbursements are not the only significant challenges facing health care
providers. Fraudulent claims and even common billing errors sent to the federal
programs potentially mean hundreds of thousands of dollars in lost revenue and
penalties – or worse.
In its report, the HHS Office of Inspector General (OIG) announced significant
audit, evaluation and investigation accomplishments for the second half of
fiscal year (FY) 2008, including savings and expected recoveries of more than
$20.4 billion – nearly 10 times the amount reported in the first half of FY2008.
The savings and expected recoveries include $16.72 billion in implemented
recommendations to put funds to better use, $1.33 billion in audit receivables,
and $2.35 billion in investigative receivables.
During the second half of FY2008 OIG excluded more than 3,000 individuals and
organizations from participating in federal health care programs, more than
double the amount of exclusions reported during the first half of the fiscal
year. The Civil Monetary Penalties Law (CMPL) authorizes OIG to impose
administrative penalties and assessments against any individual who, among other
things, submits or causes to be submitted fraudulent claims to a federal health
care program. Hospitals doing business with physicians who are excluded from
participating in federal health care programs are also in violation.
OIG concluded cases involving more than $5.5 million in penalties and
assessments in the second half of FY2008. Providers have suffered penalties
ranging from $250,000 to more than $1 million to settle volitions of the CMPL
during the last few years. OIG also brought 775 criminal actions and 342 civil
actions against individuals or organizations who engaged in crimes against HHS
programs.
“The numbers are staggering, and do not even account for the capital costs
associated with hospital resources tied up in claims management details or
participating in federal audits,” said Jeff Drake, Passport chief sales and
marketing officer. “So much revenue is lost because it is diverted to penalties.
In a time when hospitals are already struggling with increasing costs,
increasing patient financial responsibility and declining reimbursements the
overarching messages of these reports are clear – health care providers must be
more accurate and diligent in their Medicare and Medicaid billing.”
The OlG Work Plan for FY2009, published in December, is a projection of the
various projects to be addressed during the upcoming fiscal year. Several new
initiatives are planned, including OIG’s evaluation of appropriate payments for
clinical laboratory tests and hospital emergency room X-rays, variation of
laboratory pricing, Medicare billing with specific modifiers and Medicare
payments for unlisted procedure codes.
“It is evident that the OIG will continue its diligent prosecution of fraudulent
Medicare billing practices by hospitals and physicians and its auditing of
inaccurate claims,” said Patrick Harkins, vice president of content development
and compliance officer for Passport. “Providers need tools to help identify
claims that have potential issues and help them correct any errors prior to
billing. The consequences of mistakes can be extremely costly.”
Drake and Harkins encourage providers to use technology to help identify
potential issues for every claim and provide mechanisms for
correcting claims prior to being submitted to a
Medicare contractor (CI/Carrier/A/B MAC). A thorough process should include
medical necessity validation and a screening to
identify providers who have been excluded from participating in the Medicare
program (LEIE Database).
“The bottom line is that OIG is not going away,” said Harkins. “The office will
continue to audit and take action where appropriate, including prosecuting
hospitals and other facilities that violate the policies. The best way to avoid
the pitfalls is to utilize technology and processes on the front and back ends
to ensure accuracy and compliance for every claim that is submitted.”
For information about Passport’s related products and services, visit its
Web site.
About Passport Health Communications, Inc.
Passport Health Communications, Inc. is a health care technology provider
headquartered in Franklin, Tenn. Passport’s products and services are used by
more than 5,300 hospitals, physician practices and other health care providers
in all 50 states. The company delivers a range of administrative, clinical and
financial tools via real-time, batch and integrated technology to improve the
efficiency and accuracy of the revenue cycle process. For more information,
visit
www.passporthealth.com.
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